Predictors of mortality among patients undergoing colectomy for ischemic colitis: A
population-based,United States study |
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Authors: | Matthew D Sadler Nikila C Ravindran James Hubbard Robert P Myers Subrata Ghosh Paul L Beck Elijah Dixon Chad Ball Chris Prusinkiewicz Steven J Heitman Gilaad G Kaplan |
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Institution: | 1.Departments of Medicine, University of Calgary, Calgary, Alberta;2.Community Health Sciences, University of Calgary, Calgary, Alberta;3.Surgery, University of Calgary, Calgary, Alberta;4.Anesthesia, University of Calgary, Calgary, Alberta |
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Abstract: | BACKGROUND:Ischemic colitis is a potentially life-threatening condition that can require colectomy for
management.OBJECTIVE:To assess independent predictors of mortality following colectomy for ischemic colitis using a
nationally representative sample of hospitals in the United States.METHODS:The Nationwide Inpatient Sample was used to identify all patients with a primary diagnosis of
acute vascular insufficiency of the colon (International Classification of Diseases, Ninth
Revision codes 557.0 and 557.9) who underwent a colectomy between 1993 and 2008. Incidence
and mortality are described; multivariate logistic regression analysis was performed to determine
predictors of mortality.RESULTS:The incidence of colectomy for ischemic colitis was 1.43 cases (95% CI 1.40 cases to 1.47
cases) per 100,000. The incidence of colectomy for ischemic colitis increased by 3.1% per
year (95% CI 2.3% to 3.9%) from 1993 to 2003, and stabilized thereafter. The
postoperative mortality rate was 21.0% (95% CI 20.2% to 21.8%).
After 1997, the mortality rate significantly decreased at an estimated annual rate of 4.5%
(95% CI −6.3% to −2.7%). Mortality was associated with older
age, 65 to 84 years (OR 5.45 95% CI 2.91 to 10.22]) versus 18 to 34 years;
health insurance, Medicaid (OR 1.69 95% CI 1.29 to 2.21]) and Medicare (OR
1.33 95% CI 1.12 to 1.58]) versus private health insurance; and
comorbidities such as liver disease (OR 3.54 95% CI 2.79 to 4.50]).
Patients who underwent colonoscopy or sigmoidoscopy (OR 0.78 95% CI 0.65 to
0.93]) had lower mortality.CONCLUSIONS:Colectomy for ischemic colitis was associated with considerable mortality. The explanation for
the stable incidence and decreasing mortality rates observed in the latter part of the present study
should be explored in future studies. |
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Keywords: | Colectomy Incidence Ischemic colitis Mortality Temporal trends |
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